Skip to main content
Top
Published in: Radiation Oncology 1/2017

Open Access 01-12-2017 | Research

Clinical outcomes of graves’ ophthalmopathy treated with intensity modulated radiation therapy

Authors: Yong-Jiang Li, Yong Luo, Wei-Min He, Ping Li, Feng Wang

Published in: Radiation Oncology | Issue 1/2017

Login to get access

Abstract

Background

Radiation for Graves’ ophthalmopathy (GO) has traditionally utilized lateral opposing fields (LOF) or three-dimensional conformal radiotherapy (3DCRT) technique. The current study was conducted to report clinical outcomes and therapeutic effects of intensity modulated radiation therapy (IMRT) in treating GO patients.

Methods

One hundred sixteen patients with GO were treated with IMRT as initial local therapy between July 2010 and August 2013, with a median follow-up of 62 months (range 45–81 months). Radiotherapy dose was 20 Gy in 10 fractions within two to three weeks. The immediate and long-term response to IMRT was evaluated in GO severity score and in each category of symptoms. Acute and long-term complications were recorded to assess its safety.

Results

Symptom severity score significantly fell from the start of treatment to 4- or 6- month post-IMRT (P < 0.01). In total, 85 patients (73.3%) experienced improvement of GO symptoms in the first half-year, and only 4 of them (4.7%) suffered recurrence of the GO symptoms during the subsequent follow-ups. Orbital pain, tearing and extraocular muscle dysfunction had the best treatment reaction to IMRT, while proptosis and blurred vision were the most refractory symptoms. Acute complications were slight and self-limited, mainly including intermittent eye redness in 9 patients (7.8%), sideburns hair loss in 19 patients (16.4%), increased milphosis or madarosis in 23 patients (19.8%) and pseudo-progression of GO symptoms in 15 patients (12.9%). For long-term complications, chronic xerophthalmias occurred in 7 patients (6.03%), cataract developed in 2 patients (1.72%), and all were well-managed by medical interventions. Radiation retinopathy and secondary malignancy was not presented in the cohort.

Conclusion

The study demonstrated that IMRT could serve as a viable option in treating GO patients, with a satisfactory symptom control ability, and relatively slight and acceptable post-radiotherapeutic complications.
Literature
1.
go back to reference Bartalena L, Marcocci C, Pinchera A. Graves' ophthalmopathy: a preventable disease? Eur J Endocrinol. 2002;146(4):457–61.CrossRefPubMed Bartalena L, Marcocci C, Pinchera A. Graves' ophthalmopathy: a preventable disease? Eur J Endocrinol. 2002;146(4):457–61.CrossRefPubMed
7.
go back to reference Ohtsuka K, Sato A, Kawaguchi S, Hashimoto M, Suzuki Y. Effect of steroid pulse therapy with and without orbital radiotherapy on Graves' ophthalmopathy. Am J Ophthalmol. 2003;135(3):285–90.CrossRefPubMed Ohtsuka K, Sato A, Kawaguchi S, Hashimoto M, Suzuki Y. Effect of steroid pulse therapy with and without orbital radiotherapy on Graves' ophthalmopathy. Am J Ophthalmol. 2003;135(3):285–90.CrossRefPubMed
9.
go back to reference Prabhu RS, Liebman L, Wojno T, Hayek B, Hall WA, Crocker I. Clinical outcomes of radiotherapy as initial local therapy for Graves' ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery. Radiat Oncol. 2012;7. https://doi.org/10.1186/1748-717x-7-95. Prabhu RS, Liebman L, Wojno T, Hayek B, Hall WA, Crocker I. Clinical outcomes of radiotherapy as initial local therapy for Graves' ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery. Radiat Oncol. 2012;7. https://​doi.​org/​10.​1186/​1748-717x-7-95.
11.
go back to reference Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49(4):907–16.CrossRefPubMed Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49(4):907–16.CrossRefPubMed
14.
go back to reference Gerling J, Kommerell G, Henne K, Laubenberger J, Schulte-Monting J, Fells P. Retrobulbar irradiation for thyroid-associated orbitopathy: double-blind comparison between 2.4 and 16 Gy. Int J Radiat Oncol Biol Phys. 2003;55(1):182–9.CrossRefPubMed Gerling J, Kommerell G, Henne K, Laubenberger J, Schulte-Monting J, Fells P. Retrobulbar irradiation for thyroid-associated orbitopathy: double-blind comparison between 2.4 and 16 Gy. Int J Radiat Oncol Biol Phys. 2003;55(1):182–9.CrossRefPubMed
16.
go back to reference Marquez SD, Lum BL, McDougall IR, Katkuri S, Levin PS, MacManus M, et al. Long-term results of irradiation for patients with progressive Graves' ophthalmopathy. Int J Radiat Oncol Biol Phys. 2001;51(3):766–74.CrossRefPubMed Marquez SD, Lum BL, McDougall IR, Katkuri S, Levin PS, MacManus M, et al. Long-term results of irradiation for patients with progressive Graves' ophthalmopathy. Int J Radiat Oncol Biol Phys. 2001;51(3):766–74.CrossRefPubMed
17.
go back to reference Schaefer U, Hesselmann S, Micke O, Schueller P, Bruns F, Palma C, et al. A long-term follow-up study after retro-orbital irradiation for Graves' ophthalmopathy. Int J Radiat Oncol Biol Phys. 2002;52(1):192–7.CrossRefPubMed Schaefer U, Hesselmann S, Micke O, Schueller P, Bruns F, Palma C, et al. A long-term follow-up study after retro-orbital irradiation for Graves' ophthalmopathy. Int J Radiat Oncol Biol Phys. 2002;52(1):192–7.CrossRefPubMed
19.
go back to reference Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109–22.CrossRefPubMed Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109–22.CrossRefPubMed
20.
go back to reference Kinyoun JL. Long-term visual acuity results of treated and untreated radiation retinopathy (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:325–35.PubMedPubMedCentral Kinyoun JL. Long-term visual acuity results of treated and untreated radiation retinopathy (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:325–35.PubMedPubMedCentral
21.
go back to reference Takeda A, Shigematsu N, Suzuki S, Fujii M, Kawata T, Kawaguchi O, et al. Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity. Int J Radiat Oncol Biol Phys. 1999;44(3):599–605.CrossRefPubMed Takeda A, Shigematsu N, Suzuki S, Fujii M, Kawata T, Kawaguchi O, et al. Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity. Int J Radiat Oncol Biol Phys. 1999;44(3):599–605.CrossRefPubMed
22.
go back to reference Broerse JJ, Snijders-Keilholz A, Jansen JT, Zoetelief J, Klein C, Seegenschmiedt MH. Assessment of a carcinogenic risk for treatment of Graves' ophthalmopathy in dependence on age and irradiation geometry. Radiother Oncol. 1999;53(3):205–8.CrossRefPubMed Broerse JJ, Snijders-Keilholz A, Jansen JT, Zoetelief J, Klein C, Seegenschmiedt MH. Assessment of a carcinogenic risk for treatment of Graves' ophthalmopathy in dependence on age and irradiation geometry. Radiother Oncol. 1999;53(3):205–8.CrossRefPubMed
24.
go back to reference Manji N, Carr-Smith JD, Boelaert K, Allahabadia A, Armitage M, Chatterjee VK, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab. 2006;91(12):4873–80.CrossRefPubMed Manji N, Carr-Smith JD, Boelaert K, Allahabadia A, Armitage M, Chatterjee VK, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab. 2006;91(12):4873–80.CrossRefPubMed
Metadata
Title
Clinical outcomes of graves’ ophthalmopathy treated with intensity modulated radiation therapy
Authors
Yong-Jiang Li
Yong Luo
Wei-Min He
Ping Li
Feng Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-017-0908-7

Other articles of this Issue 1/2017

Radiation Oncology 1/2017 Go to the issue